Mesothelioma is treated with surgery, chemotherapy and radiation. Some patients receive experimental treatments through clinical trials. Patients today have a much higher chance of survival thanks to sophisticated surgical procedures and emerging therapies. There are specialized cancer centers across the country, including within the VA Healthcare System.
Mesothelioma Treatment Goals
Mesothelioma treatments accomplish different goals. The purpose of treatment depends on the particular patient’s case. Treatment for mesothelioma is tailored to each patient’s unique diagnosis. This gives the patient the the best chance at survival. Each patient has their own sets of factors that doctors must consider before applying the right treatment approach.
Some of the factors that determine the best treatment options for mesothelioma patients include:
- Disease location (pleural, peritoneal or pericardial)
- Disease stage (pleural mesothelioma stages 1-4)
- Mesothelioma cell type (epithelioid, sarcomatoid or biphasic)
- Patient’s age and overall level of health
There are different goals with different treatments. Doctors have to take into account all possible outcomes. This includes potential risks and benefits. In general, doctors prescribe more aggressive treatments for less advanced mesothelioma cases.
Some of the possible goals with mesothelioma treatments include:
- Removing tumors and all visible signs of mesothelioma
- Killing cancer cells to prevent them from dividing
- Targeting cancer cells and destroying tumors
- Killing cancer cells circulating throughout the body
- Improving comfort levels through pain management
- Reducing symptoms such as fluid buildup in chest and abdomen
All treatments aim to extend life expectancy or improve quality of life or accomplish both.
Mesothelioma Treatment Types
Mesothelioma patients are living longer than ever. This is thanks to tailored treatments. Mesothelioma specialists design unique treatment plans for each of their patients.
The main treatment options for mesothelioma patients include:
- Curative surgeries that aim to remove as much of the tumor as possible
- Palliative surgeries that reduce painful symptoms
- Chemotherapy that kills cancer cells and prevents them from multiplying
- Radiation therapy that targets and destroys cancer cells
- Multimodal treatments that use a combination of 2 or more treatment methods
- Emerging therapies that are tested in clinical trials and studies
Surgery offers the best chances of long-term survival for mesothelioma patients. Early-stage patients are the best candidates for surgery. But patients in all stages of mesothelioma may be eligible for surgery. If you aren’t given surgery as an option, consider talking to another doctor. A second opinion from a mesothelioma specialist can save a life.
Mesothelioma has its own unique surgeries that are designed to address the unique nature of each type of mesothelioma.
Here are the main surgical treatments available for many mesothelioma patients:
- Extrapleural pneumonectomy (EPP) for pleural mesothelioma
- Pleurectomy with decortication (P/D) for pleural mesothelioma
- Cytoreduction with HIPEC for peritoneal mesothelioma
- Pericardiectomy for pericardial mesothelioma
- Palliative surgeries for all mesotheliomas
Extrapleural pneumonectomy (EPP) is a surgery used to treat pleural mesothelioma. During this procedure, the surgeon removes the diseased lung and parts of the chest lining and the heart lining (pericardium). The doctor may also remove part of the diaphragm and/or nearby lymph nodes. The EPP is commonly used on early-stage patients. But pleural mesothelioma patients in stage 3 and 4 have benefitted from this treatment too.
The EPP removes the diseased lung and parts of the chest cavity where the mesothelioma may have spread to. This is why it can improve a patient’s life expectancy.
Did You Know? On average, a patient can double their life expectancy from 12 to 24 months with an EPP. Some patients have gone on to live 5 or more years thanks to their EPP surgery.
The EPP for pleural mesothelioma was pioneered by Dr. David Sugarbaker. He has spent the last 30 years developing this surgery so that more patients can benefit from it. Experts feel that survival rates will only continue to increase as specialists work to refine and develop the EPP technique giving it a greater success rate.
Pleurectomy With Decortication
The pleurectomy with decortication (P/D) is another type of surgery used to treat pleural mesothelioma patients. Patients who undergo P/D keep their lung. P/D involves a two-part surgery. First, the surgeon removes the diseased pleura (lung lining). This is the pleurectomy. Then the surgeon removes visible tumor masses in the chest cavity. This process is known as decortication. Some consider P/D to be a better option compared to EPP because it spares the lung.
Like any form of surgery, P/D is only performed on candidates who are in good enough overall health to withstand surgery. Like EPP, P/D is typically performed on early stage pleural mesothelioma patients. Yet, some advanced stage patients are candidates for P/D.
The P/D was initially developed as an alternative to EPP by Dr. Robert Cameron of UCLA Medical Center. Dr. Cameron has spent over two decades refining the procedure to ensure greater rates of success. As surgeons continue to refine the procedure, they can increase survival rates and save more patient lives.
Though each surgical technique has passionate proponents on either side, EPP and P/D have both proven to significantly improve patient life expectancies. Like the EPP, P/D also doubles the average patient life expectancy.
Cytoreduction with HIPEC is the only surgical procedure for peritoneal mesothelioma. It’s a two-part surgical procedure.
First, the surgeon uses a surgical technique called cytoreduction. The surgeon removes as much of the visible tumors as possible. This includes removing the diseased peritoneum (peritonectomy).
Second, the surgeon circulates heated chemotherapy in the abdomen. This is called hyperthermic intraoperative chemotherapy (HIPEC). It helps kill off any remaining cancers cells in the abdomen. Dr. Paul Sugarbaker developed this operation for peritoneal mesothelioma.
Did You Know? Cytoreduction with HIPEC has resulted in an average life expectancy of 3 years for patients who undergo this surgery.
Pericardiectomy is used to treat pericardial mesothelioma. During a pericardiectomy, the surgeon removes part or all of the diseased pericardium. This is the lining of the heart.
A pericardiectomy may be used as a curative surgery or a palliative surgery to help alleviate painful symptoms like difficulty breathing. In some cases, a pericardiectomy has significantly extended life expectancy. Combining a pericardiectomy with chemotherapy has allowed some patients to live longer than three years after their diagnosis.
Palliative surgeries help increase comfort levels by alleviating symptoms. There are many types of palliative surgeries. Each type depends on the location of the mesothelioma.
Most palliative surgeries involve removing parts of the diseased mesothelium and draining fluid buildup. This helps the patient reduce their swelling, breathe easier and eliminate tightness in their chest or abdomen. It also helps them eat more and move better than before.
Palliative surgeries don’t usually extend life expectancy. But they can help mesothelioma patients live without pain and discomfort.
Here are the different types of palliative surgeries:
- Pleurodesis: Prevents fluid buildup in the pleura
- Thoracentesis: Drains excess fluid between the lungs and the pleura
- Pericardiocentesis: Drains excess fluid in the pericardium
Mesothelioma specialists are the only ones who can adequately determine if a patient is a good candidate for curative surgeries or palliative surgeries. Palliative surgeries are excellent options that specialists recommend for helping to improve a patient’s quality of life.
Chemotherapy is the most common form of treatment for mesothelioma. It involves regularly administering an anticancer drug to the patient. Chemotherapy drugs are given in cycles. Chemotherapy is typically administered intravenously in a three-hour session every three weeks. Patients usually receive 3-4 rounds of these sessions.
Chemotherapy can also be taken in pill form. There are many types of chemotherapy drugs, but mesothelioma patients usually take a combination of a drug called cisplatin and other chemo drugs.
Chemotherapy drugs work to stop cancer cells from multiplying. This helps slow the disease progress. Chemotherapy is often combined with surgical procedures. Chemotherapy drugs help kill remaining cancer cells that surgeons weren’t able to remove.
Chemotherapy can be administered before (neoadjuvant) or after (adjuvant) surgical procedures.
Chemotherapy may produce side effects like hair loss and fatigue. It’s a non-invasive treatment that can be tailored to each patient’s needs.
Radiation is given in addition to other treatments. Radiation helps patients at all stages of mesothelioma. Radiation therapy uses high-energy rays aimed directly at mesothelioma tumors. Radiologists map out the location of the tumors so they know where to aim the radiation.
Radiation interferes with the DNA of mesothelioma cells. This prevents them from receiving instructions to multiply. If mesothelioma cells stop multiplying, they cannot spread. This slows disease progress.
Radiation can be administered non-invasively using external beams. Or radiation can be administered intraoperatively. Intraoperative radiation is applied directly to tumors during open surgery.
Mesothelioma treatments require specialized knowledge. The doctor must understand each patient’s individual diagnosis. That’s why it’s critical to receive treatment from a mesothelioma specialist as opposed to a general oncologist.
Specialists can put together a tailored treatment plan that addresses each unique patient case. This gives patients the best chance at survival.
The veteran’s VA Healthcare Network and private cancer centers across the nation are home to the world’s top mesothelioma specialists. These specialists include:
- Dr. David Sugarbaker. He’s a pleural mesothelioma specialist known for pioneering the extrapleural pneumonectomy procedure. Dr. David Sugarbaker is the Chief of Thoracic Surgery at Baylor St. Luke’s Medical Center in Houston, TX.
- Dr. Robert Cameron. He’s a pleural mesothelioma specialist known for developing the pleurectomy with decortication procedure. Dr. Cameron works out of the UCLA Medical Center and the Los Angeles VA.
- Dr. Paul Sugarbaker. He’s a peritoneal mesothelioma specialist known for developing the cytoreduction with HIPEC technique. Dr. Paul Sugarbaker works out of the Washington Cancer Institute in Washington, DC.
- Dr. Avi Lebenthal. He’s a mesothelioma specialist dedicated to treating veteran patients. Dr. Avi Lebenthal is the director of the mesothelioma program at the Boston VA Healthcare System.
Mesothelioma Cancer Centers
It’s vital to work with a mesothelioma specialist at a designated mesothelioma cancer center. This ensures you get the best chance of extending your life expectancy and improving your quality of life. These healthcare professionals are dedicated to working with veterans.
Contact any of the following mesothelioma cancer centers today or call one of our patient advocates to set up an appointment:
- Brigham and Women’s Hospital in Boston, MA
- Mayo Clinic in Rochester, MN
- Boston VA Healthcare System in Boston, MA
- UCLA Medical Center and the Los Angeles VA in Los Angeles, CA
Finding and Affording Treatment
These world class mesothelioma medical centers understand the financial burdens that veterans and their families undergo during a mesothelioma diagnosis. That’s why the administrators work directly with the patient’s insurance provider to ensure that their medical claims are taken care of.
Not all patients have insurance coverage for their mesothelioma diagnosis. Thankfully, veterans with mesothelioma diagnoses have important financial support options that alleviate the burden of medical costs. These include government-funded VA treatment programs as well as private asbestos trust funds for patients and their families.
Veterans who developed mesothelioma as a result of their military service are eligible for benefits and financial aid through several different agencies and organizations. The Department of Veterans Affairs is one of the most important organizations for mesothelioma veterans. The VA connects eligible veterans with mesothelioma treatments. These treatments are sometimes through government-funded clinical trials that provide promising emerging therapies.
Veterans can find financial help for treatment through:
- VA-affiliated mesothelioma specialists like Dr. Lebenthal
- Disability benefits and veterans pension
- Mesothelioma trust funds for victims of asbestos exposure
If you are a veteran with a mesothelioma diagnosis, you are not alone. There are so many resources and programs available to help support your treatment and recovery. Contact our VA claims agents today to learn more about your options.